Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection
Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection
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DOI：
10.1001/jama.2023.8823
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发表时间：
2023-05-25
影响因子：
120.7
通讯作者：
Foulkes, Andrea S.
中科院分区：
文献类型：
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作者：
Thaweethai, Tanayott;Jolley, Sarah E.;Foulkes, Andrea S.
SARS-CoV-2感染与SARS-CoV-2感染后持续、复发或新的症状或其他健康影响有关，称为SARS-CoV-2感染的急性后遗症(PASC)，也称为长冠状病毒感染。PASC的特征需要对从不同的未感染和感染的个体收集的前瞻性和统一的数据进行分析。目的利用自我报告的症状制定PASC的定义，并描述PASC在队列、疫苗接种状态和感染人数中的频率。设计、设置和参与者在33个州以及华盛顿特区和波多黎各的85个登记地点(医院、卫生中心、社区组织)对患有和不患有SARS-CoV-2感染的成年人进行前瞻性观察队列研究。在2023年4月10日之前登记在恢复成人队列中的参与者，在急性症状出现或测试日期后6个月或更长时间完成症状调查。选择包括基于人群、志愿者和便利抽样。调查SARS-CoV-2感染。主要结果和测量PASC和44名参与者报告的症状(带有严重程度阈值)。结果共有9764名参与者符合选择标准(89%的SARS-CoV-2感染；71%的女性；16%的西班牙裔/拉丁裔；15%的非西班牙裔黑人；中位年龄47岁[智商，35-60])。调整后的优势比为1.5或更高(感染与未感染的参与者)，37个症状。导致PASC评分的症状包括劳后不适、疲劳、脑雾、头晕、胃肠道症状、心悸、性欲或能力改变、嗅觉或味觉丧失或改变、口渴、慢性咳嗽、胸痛和异常运动。在2231名在2021年12月1日或之后首次感染，并在感染后30天内登记的参与者中，224人(10%[95%可信区间，8.8%-11%])在6个月时PASC阳性。结论与相关性在前瞻性队列研究中，根据症状制定了PASC的定义。作为为其他研究提供框架的第一步，需要进一步结合其他临床特征的迭代改进，以支持对PASC的可行定义。
IMPORTANCE SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.OBJECTIVE To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.DESIGN, SETTING, AND PARTICIPANTS Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling.EXPOSURE SARS-CoV-2 infection.MAIN OUTCOMES AND MEASURES PASC and 44 participant-reported symptoms (with severity thresholds).RESULTS A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.CONCLUSIONS AND RELEVANCE A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.